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Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral StudiesCollection
2017
Development of a Transformational,
Relationship-Based Charge Nurse Program
Kimetha D. Broussard
Walden University
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Walden University
College of Health Sciences
This is to certify that the doctoral study by
Kimetha Broussard
has been found to be complete and satisfactory in all respects, and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Marisa Wilson, Committee Chairperson, Nursing Faculty Dr. Murielle Beene, Committee Member, Nursing Faculty
Dr. Jonas Nguh, University Reviewer, Nursing Faculty
Chief Academic Officer Eric Riedel, Ph.D.
Walden University 2017
Abstract
Development of a Transformational, Relationship-Based Charge Nurse Program
by
Kimetha D. Broussard
MS, University of Oklahoma, 2004
BS, Southwestern Oklahoma State University, 1996
Project Submitted in Partial Fulfillment of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University August 2017
Abstract
Leaders of a rural Southwest Oklahoma hospital requested the development of an evidence-based program that could transform unit charge nurses into effective leaders in order to improve the leadership of direct care nurses. Nursing executive leadership discovered staff members were demonstrating high levels of stress, dissatisfaction, and burnout. Press-Ganey survey results revealed that staff felt they were not supported and did not believe nurses cared for patients’ or other co-workers’ well-being or safety. The Hospital Consumer Assessment of Healthcare Providers and Systems outcome scores which were below hospital and national desired benchmarks revealed that patients were not satisfied with the care they received. Thus, the goal of this project was to use evidence to craft a program and evaluation plan that could be used by the hospital to develop stronger charge nurse leaders. A detailed examination of evidence supported the development of a program based on the relationship-based care (RBC) model. The RBC model is a transformational leadership development program that increases leadership skills and positive interaction between people. A full program was adapted from the RBC model and designed for the rural hospital. An evaluation plan to measure the short-and long-term objectives was developed. Implementation is expected to create social change by imparting charge nurses with leadership and relationship skills, thus empowering them with greater abilities to provide care. Benner’s novice to expert and Watson’s theory of
caringmodels served as the foundation of the RBC model. The goal is to present the
results at the hospital level and to disseminate the findings locally at professional nursing leadership conferences.
Development of a Transformational, Relationship-Based Charge Nurse Program
by
Kimetha D. Broussard
MS, The University of Oklahoma, 2004 BS, Southwestern Oklahoma State University, 1996
Project Submitted in Partial Fulfillment of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University August 2017
Dedication
This project is dedicated to charge nurses employed in healthcare hospitals who feel they were selected as the next one up for the charge nurse position but were not granted the benefit of attending a formal leadership program. This project is also in dedication to those up-and-coming charge nurses who will be granted the privilege of attending a relationship based care program. The relationship-based care charge nurse program was developed to bring about a sense of leadership, competency and self-empowerment in performing the charge nurse role.
Acknowledgments
The project completion was with the support and encouragement of my family and friends. First, I would like to send a huge thank you to my precious and beloved mother who was my best friend and greatest life supporter. Thank you for always encouraging me to do more, to reach higher and to lend a hand-up to bring others along the way. Next, to my husband, who believed in me, constantly prayed for me and who funded my educational endeavors as a life-long learner. To my children, grandchildren and sister who supported me and told me I could do it when I felt overwhelmed and ready to throw in the towel. I thank everyone who contributed in any form, great or small, and believed I could obtain a doctoral of nursing practice degree.
I would like to thank all my Walden professors and especially my project committee chair, committee member and URR for their support and encouragement during my development as a doctor of nursing practice. This project would have been difficult beyond measure without the support and guidance of my preceptor. I would like to thank you for supporting the advancement of the nursing profession by being an exceptional preceptor and mentor. Lastly, but above all, I thank God and Jesus Christ, my father, in whom I can do all things.
i
Table of Content
List of Tables ...v
Section 1: Nature of the Charge Nurse Project ...1
Introduction ...1
Problem Statement ...4
Significance and Relevance to Practice ...5
Purpose Statement and Project Objectives ...7
Project Question ...8
Reductions in Gaps ...8
Implications for Social Change in Practice ...10
Definition of Terms...11
Scope of the Study ...12
Assumptions ...13
Limitations ...14
Delimitation ...14
Summary ...15
Section 2: Review of the Literature ...16
Introduction ...16
Specific Literature of a RBC Charge Nurse Program ...17
General Literature of Charge Nurse Leadership ...21
Conceptual Models and Theoretical Framework ...25
ii
Section 3: Methodology ...29
Approach ...29
Course Objectives ...30
Course Modules ...31
Module 1: Charge Nurse’s Role and Job Description ...31
Module 2: Leadership Styles and Completion of the Self-Assessment Pretest ...31
Module 3: Foundations of Empowerment ...32
Module 4: Responsibility, Authority, and Accountability (R+A+A) ...33
Module 5: Disciplines of Execution using principles of I2E2 ...33
Module 6: Building Trusting Relationships ...34
Module 7: Crucial Confrontations ...35
Module 8: Effective and Ineffective Communication ...35
Module 9: Appreciative Methods ...36
Module 10: Lean Methodology ...36
Module 11: Hospital Nuts and Bolts ...37
Module 12: Summary, Self-Assessment Posttest and Program Evaluation ...37
Population and Sample ...38
Program Design ...39
Data Collection ...39
Data Analysis ...42
iii
Summary ...44
Section 4: Findings and Recommendations ...45
Introduction ...45
Findings and Implications ...46
Discussion ...48
Positive Social Change ...49
Recommendations ...51
Contribution of the Doctoral Project Team ...54
Strength and Limitations of the Project ...57
Program Strengths ...57
Limitations of the project ...58
Summary ...58
Section 5: Dissemination Plan of the Scholarly Product.... ...59
Introduction ...59 Dissemination ...60 Analysis of Self ...63 Scholar ...64 Practitioner ...64 Project Manager ...65 Project Completion ...66 Summary ...67 References ...69
iv
Appendix A1: Creative Health Care Management Approval Letter ...74
Appendix B1: Leadership Personal Assessmenmt ...76
Appendix C1: RBC Charge Nurse Program Agenda ...80
Appendix D1: Development of a Charge Nurse Program ...81
v List of Tables
Section 1: Nature of the Charge Nurse Project
Introduction
There is an urgent need and demand for professional development programs for unit-based leaders or charge nurses (Duygula & Kublay, 2011; Fairbairn-Platt & Foster, 2008; Sherman, 2005; Swearingen, 2009). However, very little effort has gone into identifying effective programs (Thomas, 2012). Ongoing reports of unprepared charge nurses taking on the dynamic role may be related to hospitals’ delay in providing formal training programs (Duygula & Kublay, 2011; Sherman, 2005; Swearingen, 2009). In the hierarchy of nursing leadership, the role of the charge nurse is to direct acute patient care services to a team of nurses. The charge nurse is responsible for safe and effective care provided on the nursing unit. As the lead, the charge nurse sets the expectations and goals for the nursing staff to improve patient outcomes. The current system of transforming charge nurses into effective leaders is not meeting the needs of nurses or patients;
therefore, the recommendationof Duygula & Kublay (2011) is for the implementation of
nursing leadership programs. Often times, when effective charge nurse-leadership is lacking: job satisfaction, nurse retention, and patient care outcomes suffer (Duygula & Kublay, 2011). But in healthy environments, strong charge-nurse leaders increase staff productivity and morale, improve turnover rates, decrease morbidity and mortality rates and improve patient outcomes (Duygula & Kublay, 2011).
The role of the charge nurse is recognized as a leadership position that improves patient care outcomes on nursing units. Krugman and Smith (2003) reported that “the
charge nurse role has been a part of the nursing management structure for over 20
years…proving its durability over time…although not without identified issues related to how this role is structured and implemented” (p. 285). Therefore, to overcome the issue of leadership development, it is essential that hospitals implement theory-based nursing practice models into the charge nurse system. A theory-based driven program transforms charge nurses into effective leaders who can meet the needs of other staff nurses and patients (Duygula & Kublay, 2011). According to Schwarzkopf, Sherman, and Kiger (2012), nurses who do not go through formal educational programs to develop into effective charge nurses are not prepared to take on the challenges of the leadership role.
Therefore, active participation in a leadership development program may advance clinical practice by producing charge nurses who are able to meet the demands of the current healthcare system (Duygula & Kublay, 2011; Swearingen, 2009). The charge nurses who participate in such programs learn leadership tools, develop new attitudes and skill sets that lead team members into achieving quality healthcare outcomes (Swearingen, 2009). The charge nurse, when given the opportunity to develop leadership skills, can also play an important role in leading change on the hospital unit (Krugman & Smith, 2003; Krugman, Heggem, Kinney & Frueh, 2013).
The rural 200-bed southwestern Oklahoma acute care hospital, in which this DNP project was carried, out contracted with the consultation firm, Creative Health Care Management, Inc. (CHCM), in June, 2014. The firm’s consultation services were needed because of high employee turnover rates and multiple reports of dissatisfaction from both
patients and staff members. The hospital also wanted help to identify what hospital changes were needed to recreate a healthy work environment. The CHCM consultants recommended completion of a hospital self-assessment in order to measure patient and family relationships, caring and healing behaviors, leadership, teamwork, professional practice, care delivery, and resource-driven outcome criteria. The score was based on a scale of 1-to-10 with 1 meaning the current state does not exist and 10 meaning the desired state strongly exists. If 10 is achieved within this organization, excellence was identified for this area. After the CHCM company completed the hospital’s
self-assessment, the hospital’s nursing directors completed individual nursing unit level need-assessments. Lack of staff support, guidance, training, and supervision were issues identified as recurring themes by the hospital’s nursing executive leadership team. This team identified that caring relationships between staff and patients, nurses and
physicians, nurses-to-nurses and staff with nursing leadership were in dire need of improvement. The senior director of nursing and other leadership members identified a potential area of improvement was the ineffectiveness of nursing unit-level leadership. The executive leadership team agreed a starting point for reaching a potential solution to the issue of ineffective leadership at the unit level and to improve caring relationships between team members and patients was revising the current charge nurse program (K.H., personal communication, June 10, 2014).
To help fill this gap in practice, according to Koloroutis (2004), the
program that is geared toward charge nurses should be implemented. The
transformational (RBC) program brings about unit-based changes in patient outcomes. In the transformational RBC care model, particular skills missing in the hospital’s current charge nurse program are identified such as patient and staff caring relationships, conflict resolution, life and work balance, and shared governance (Koloroutis, 2004). The
concepts of the RBC model are related to care delivery between the patient and family, other care providers, and the care provider and self. Therefore, the nursing leadership assumed that the following steps improve patient and staff relationships on the unit: (a) blending CHCM’s RBC leadership styles, (b) incorporating team leading, team building and teamwork skills, (c) teaching conflict management resolutions strategies, (d)
demonstrating effective communication and listening skills, and (e) introducing
appreciative inquiries components into the hospital’s current charge nurse program. The assumption was that including the RBC evidenced-based program creates caring
relationships within the hospital and improve overall staff performance and patient outcomes (K.H. personal communication, June 10, 2014).
Problem Statement
The hospitalcurrently provides charge nurses with a one-day workshop on how to
perform general charge nurse duties such as staffing the nursing unit. But despite charge nurse program attendance, the hospital’s quality improvement benchmarks continued to be below the desired levels (K.H., personal communication, June 10, 2014). The project hospital experienced a voluntary and involuntary turnover of employees in 2014. During
that time, the nursing executive leadership team discovered that staff members were
demonstrating high levels of stress, dissatisfaction, and burnout in every nursing
department. The results of the hospital’s Press-Ganey survey indicated that staff members felt they were not supported and did not believe nurses cared for patient’s or other co-worker’s well-being or safety. The Hospital Consumer Assessment of Healthcare
Providers and Systems (HCAHPS) outcome scores were below the hospital’s and desired national benchmarks. The scores indicated that patients were not satisfied with the care they received. According to the results of the National Data Nursing Quality Indicators (NDNQI), the hospital’s metrics all scored unfavorably in staff hand washing, fall rates,
length of stay, and patient-to-nurseratios. After the reported concerns were assessed,
executive leadership decided it was in the best interest of the hospital to make changes in many positions held by unit managers, directors, and staff (K.H., personal
communication, June 10, 2014).
Significance and Relevance to Practice
The lack of leadership development for charge nurses working on medical-surgical units is a nursing and hospital issue. However, it can be overcome with
leadership program attendance where effective leadership strategies are instilled in charge nurses (Koloroutis, 2004). The project hospital needed to implement the RBC charge nurse program for registered nurses in order to gain the self-confidence, skills, and abilities necessary to successfully lead the healthcare team. Nurse leaders believed implementing the RBC program may result in improvement in patient satisfaction and
outcome scores, decrease nurse turnover rates and increase job satisfaction. See Table 1 for the Hospital’s 2014 Balanced Scorecard.
Table 1.
2014 Hospital’s Balanced Scorecard.
Customers Performance measures Actual Goal
HCAPHS: Recommend this hospital to family or friends?
Meet or exceed national standards
72% 77%
Discharge calls 80% response rate 48% 52%
Quality indicators
Falls rates Fall rates >3/1000 pt
days
4.88/1000 3.67/1000
Hand washing 100% compliance rate 69% 80%
Nursing Turnover of medical/surgical RN Voluntary RN turnover rates reduced by 10% 28.89% 14.69% Job satisfaction Intent to stay Retention rates increased by 75% 37% 75% Finance Productivity RN contract labor Agency/contract RNs reduced by 70% $1,519,181.99 $546,000.00
Supplies medical/surgical Annual budget
sustained
$202,730.00 $193,797.95
The hospital’s leadership acknowledged the importance of supporting the implementation of a formal charge nurse program because it would allow for
transformational development and healthcare changes needed within the hospital. Leaders were confident the RBC principles and strategies may lead to transformational
development of leaders in the form of improved communication skills and enhanced relationships between disciplines. The hospital leadership also were confident that charge
nurse program attendance would show a decrease in frustration with the job, increase nurses’ intent to stay at the hospital and improve job satisfaction with the hospital in nurses, physicians, patients and family members.
Purpose Statement and Project Objectives
The purpose of this project was to develop a scholarly program plan, based on the best available evidence-based literature, for blending the hospital’s current charge nurse program with the recommended RBC program. The hospital was interested in knowing if blending the two programs could help transform unit charge nurses into effective leaders who were prepared to take on the roles and responsibilities of the position. An additional purpose was to complete a search of the evidence-based literature for the optimal method to plan and implement the program in the future. The final purpose was to help the hospital identify program evaluation methods to apply to the future results of the blended charge nurse program.
This study had five objectives: (a) charge nurses would report that they can demonstrate effective leadership abilities and skills after completing a transformational RBC program. It was projected that charge nurses with effective leadership abilities would improve both staff and patient metrics, such as staff turnover, patient fall rates, medication errors, infection rates, and a number of other staff and patient safety metrics. (b) following participation in the quality improvement program, charge nurses would report enhanced communication skills and decision-making abilities while helping other nurses to function within the context of a relationship-based model of care. (c) the charge
nurses would report having an increased sense of empowerment and autonomy. (d) charge nurses would report having the ability to show compassion and caring behaviors to patients, co-workers and self alike, as a result of learning principles and strategies in the RBC program. (e) the hospital would report improved nurse-driven outcome metrics after the implementation and evaluation of the RBC formal charge nurse program.
Project Question
• Will the development of a charge nurse RBC program that leads to achieving
personal, professional, and hospital goals, be supported by scholarly literature?
• Will the implementation of a charge nurse program improve the quality of
patient care outcomes, as supported by the scholarly evidence-based literature?
Reductions in Gaps
The effectiveness of the charge nurse leader is important to nursing practice. Nursing practice decisions made by charge nurses impact critical unit measurements, such as the safety and satisfaction of patients, physicians, and staff (Krugman, Heggem, Kinney & Frueh, 2013; Maryniak, 2013). These decision-making skills are required to assist charge nurses in improving their nursing knowledge and learn their role
expectations, such as improving other staff members’ performance, satisfaction, and intent to stay (Maryniak, 2013). Effective charge nurse-leadership is also important to maintain the function and flow of the nursing unit. Staff turnover rates, unit morale,
patient and physician satisfaction, and patient care outcomes are areas of the hospital infrastructure that are identified indicators which reflect the actions of the charge nurse.
The charge nurse role and the development of registered nurses into strong effective leaders is imperative to close the gaps in practice (Duygulu & Kublay, 2011; Galuska, 2012; Krugman, Heggem, Kinney & Frueh, 2013; Krugman & Smith, 2003; Maryniak, 2013). According to Galuska (2012), leadership competencies are required to develop effective charge nurses, but this “development… has not been systematic,
reliable, or lifelong” (p. xxx). Galuska continued: “As a result, not all nurses are prepared for the transformational leadership roles essential to fundamentally changing the health care system” (p. 333). Krugman, Heggem, Kinney and Frueh (2013) suggested that for decades’ charge nurses have experienced problems taking on the charge nurse role and responsibilities whether due to “poor fit” or “lack of adequate preparation” (p. 438).
Although, genuine leadership in the nursing profession is an essential component of nursing practice, closing the gap is daunting. Finkelman and Kenner (2010) suggested that reviewing scholarly studies on transformational leadership could help reduce the gaps in practice. They concluded that an extensive review of the literature could help to identify, select, implement, and evaluate effective leadership strategies. However, information on transformational leadership and strategies are lacking in the nursing literature. Similarly, Thomas in 2012 reported that also lacking in the leadership literature, but desperately needed are studies on the development of front-line nurses.
Currently, in academia, transformational leadership-theory is widely used in nursing leadership courses to train future registered nurses on how to function as effective leaders (Garon, 2014). However, implementing the knowledge learned in nursing school does not always transfer to the clinical practice setting, therefore, early development programs should be readily available for new graduates. In addition, to
reduceidentified gap in practice is the support and valuable resources needed from
hospital leaders to promote autonomous charge nurses’ decision-making efforts.
Implications for Social Change in Practice
Charge nurses who participate in development programs are effective in their leadership role. They demonstrate increased satisfaction, exhibit attributes of autonomy, commitment, and passion for the profession. Empowered charge nurses are effective at applying learned leadership skills, knowledge, and strategies acquired during
participation and implementation of the program (Koloroutis, 2004). The goal of this DNP developmental project was to reduce or eliminate poor leadership qualities in charge nurses in this rural hospital, and to encourage other hospitals to implement the program.
The implementation of a quality improvement program to develop charge nurses into leaders could create a social change at the hospital and within the local community (Koloroutis, 2004). A social change in the local community may include increased awareness of disease processes and safety measures. This program may result in an atmosphere of increased employee ownership, commitment, and professional loyalty. A social change in the development of charge nurse leadership may lead to new program
initiatives for patients and other employees within the hospital setting. Other social changes are reductions in staff and physician’s dissatisfaction, decreased lengths of stays, reduced patient falls, and pressure ulcers may also be realized due to charge nurse
program participation. The impact from program participation may be a social change for improved relationships between the residents in this southwest Oklahoma community and the hospital because they may start to trust the hospital and nurses to deliver the good healthcare they promise.
The communities in southwest Oklahoma consist mainly of scattered rural populations. Based on the successful implementation of this RBC leadership program, a societal change in rural nursing practice and knowledge may foster new ways where
other rural hospitals can provide similar charge nurse programs. In addition,the
empowerment of leadership competencies realized from charge nurse development may create a snowball effect in the local community that impact healthcare delivery. Lastly, the implementation may shape healthcare policies that influence charge nurse’s future development, knowledge, judgment, and satisfaction in the hospital thereby, elevating the profession of nursing as a whole.
Definition of Terms
The concept selected for this developmental project was leadership.
Leadership: the power to lead and guide followers into action (Covey, 2004).
Charge nurse: an assigned registered nurse unit leader with at least two years of
Relationship-based care: a care delivery model and philosophy that focus on
patients, colleagues and self (Koloroutis, 2004).
Responsibility: the clear and specific allocation of duties visibly given and
accepted in order to achieve desired results (Koloroutis, 2004).
Authority: the right to act and make decisions at the appropriate level (Koloroutis,
2004).
Accountability: taking responsibility and ownership for one’s own actions and
decisions (Koloroutis, 2004).
Transformational leader: “one who commits people to action, who converts
followers into leaders, and who may convert leaders into agents of change” (Bennis & Nanus (1985, p.3)
Transformational: the capacity to impact change in a given situation.
Transformational relationship-based care: a concept to develop leaders at all
levels into change agents who inspire caring behavior and create healing environments that impact a person’s mind, body, and spirit (Koloroutis, 2004).
Scope of the Study
This project was created to increase leadership abilities and competency in this southwestern Oklahoma rural hospital’s charge nurses. The charge nurses were registered nurses with at least two-years clinical practice experience. The hospital leaders believed that patient-care outcomes were connected to charge nurse leadership on the units. The program included 12 modules that were created in the development of this charge nurse
program using the RBC model principles. The modules were written to increase charge nurses’ abilities in reaching their full potential as leaders. The RBC principles included in the modules are effective communication, conflict management, teamwork, building trusting relationship and responsibility, accountability and authority in the leadership role (Koloroutis, 2004). According to Koloroutis, this RBC program geared toward the
development of leaders has been successfully implemented at other hospitals. The results of the program on charge nurse competency and leadership abilities lead to improved patient outcomes and increased charge nurses’ satisfaction in the position.
Assumptions
The assumptions are not able to test or determine whether the project statements are true or false (Groves, Burns, & Gray, 2013). The hospital leadership team believed that charge nurses are able to learn new skills and apply those skills to nursing practice. They also thought charge nurse participation would increase self-empowerment. These were the assumptions of participation in a RBC leadership program:
1. The development of a charge nurses program increases learned leadership skills and knowledge that will be applied in clinical practice.
2. The charge nurse program modules are provided at a level where participants gain increased self-confidence, self-awareness, and competence through learning new leadership skills.
Limitations
The limitations are weaknesses that may alter the results of the project (Groves, Burns, & Gray, 2013). The limitations of the future RBC leadership program are as follows.
1. The program results are based on charge nurses’ self-reported surveys. 2. The program will be conducted at one rural hospital therefore, may not be
generalized to all charge nurses.
3. The implementation and evaluation processes for this project may not be generalized to other rural hospitals.
Delimitation
The purpose of this project was to develop a scholarly program plan for blending
the hospital’s current charge nurse program with the recommended RBC program. Other leadership programs were available and recommended in the nursing literature but it was determined that those programs were not feasible because the hospital desired to
incorporate the RBC leadership program. An additional purpose was to complete a search of the evidence-based literature for the optimal method to plan and implement the program in the future. There were several choices identified in the literature as to how many days a charge nurse program should be provided. The most frequent
recommendation was for a full one-day, eight-hour program. The RBC consultants also suggested a one-day program as being sufficient (Koloroutis, 2004).
Summary
There was an immediate need within this hospital for a developmental program and implementation plan for transforming charge nurse-leadership abilities in clinical practice. The negative results of patient outcome matrixes and the reported dissatisfaction among staff and patient supported the need for strategies to help reduce the gaps in practice. The literature supported that clinic nursing practice needed a transformation of the charge nurse role and that participation in a development program may help to reduce the gaps. Program participation was identified as a strategy available to help increase charge nurse’s qualities of autonomy, confidence, and the empowerment to lead others to the next level. It was also suggested that a transformational development program such as RBC could solidify the leadership attributes of accountability, authority and
responsibility in charge nurses. Although some charge nurses may not actively practice at the bedside, their leadership abilities and decisions-making skills impact the hospital’s nursing staff and patient care outcomes in a positive manner. The evidence-based
literature search supported the idea that effective leadership abilities may improve patient care outcomes. Therefore, it is important for hospitals to provide programs that build upon and strengthen existing charge nurse leadership abilities, capacities, and care practices.
Therefore, the project’s aim was to design, develop, and implement a transformational relationship-based care program and evaluate whether unit charge nurses’ developed leadership skills and empowerment after participating in a one-day,
eight-hour program. Koloroutis (2004) reported that implementation of the RBC concepts may likely bring about positive changes in staff and patient outcomes.
To help hospital leaders decide whether the RBC model potentially transforms nursing care at the bedside, the project team conducted a literature review search on other hospitals that used the RBC model. To investigate the use of the RBC model, a specific and general review search of available evidence-based literature was conducted by the project team. The following section explored nursing concepts, models, and theoretical frameworks to select a program to blend into the project’s existing charge nurse program.
Section 2: Review of the Literature
Introduction
The review of the literature consisted of a general literature search of leadership competency and the impact on charge nurse’s abilities. An additional leadership review search was completed on the specific literature of transformational leadership programs. Benner’s novice to expert model and Watson’s human caring models were also reviewed for use in a transformational development program for charge nurses.
The main purpose of this project was to plan and then recommend an evidence-based program to develop charge nurse leaders. An additional purpose was to help project program leaders to develop a program based on the RBC principles of leadership that was ready for future implementation and evaluation. One of the determining factors for
program implementation was effectual charge nurses are viewed as vital role models and mentors for inexperienced nurses aspiring to advance to the charge nurse position.
Unfortunately, when formal leadership education is denied, many charge nurses lack the essential qualities and are ill-prepared to foster another nurses’ growth.
Consequently, a literature search for charge nurse programs in general and specifically for transformational relationship-based development programs was conducted. The Walden’s University Library Thoreau portal databases in EBSCO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, and Ovid full text were searched for the following keyword: charge nurses, front-line leaders,
leadership, transformational leaders, development programs, and RBC. The literature
search was limited to the years 2000 to 2016. Several articles were found on the discipline of leadership, but very few on nursing leadership and RBC.
Specific Literature of a RBC Charge Nurse Program
The literature searches revealed that the development of leaders continues to be an issue. According to Koloroutis (2004), new charge nurses who have not participated in professional development programs experience role confusion related to responsibility, accountability, and authority because they have not traditionally been the final decision makers. Koloroutis suggested that leadership development may create positive
characteristics consistent with RBC qualities. Relationship-based characteristics consist
of the desire to make the business, others, and oneself function at optimal capacity.The
RBC nurse is concerned about what matters to the patient, co-workers, and others. According to Koloroutis, charge nurses can be transformed into professional leaders who
provide relationship-based, patient-centered care once provided the opportunity to develop by way of a tailored program.
In the evidence-based nursing literature on charge nurses and managers, it was reported that nurses were denied the benefit of attending leadership developmental
programs (McCallin & Frankson, 2010;Thomas, 2012). Several of the medical-surgical
charge nurse participants in these qualitative descriptive studies reportedthey mostly
learned management skills by trial-and-error and the occasional attendance at
management workshops (McCallin & Frankson, 2010;Thomas, 2012). Galuska (2012)
added thatmost nursing leaders have not had the privilege of participating in
transformational leadership development programs, but if they had, “the training has been fragmented and unable to make a meaningful impact on charge nurses’ leadership skills”
(p. 333).Such fragmentation will need to change if healthcare is to reap the benefits of
training on staff and on patient care outcome.
Duygula and Kublay (2010) and Krugman et al. (2013) conducted studies to investigate whether charge nurse’ leadership abilities would increase after attending a charge nurse leadership-training program. Both studies findings suggested participation in a leadership development program may advance clinical practice by developing skill sets on ways to effectively lead team members in hospitals. Krugman and Smith (2003) also acknowledged charge nurse participation in professional development programs play an important role in creating change in leadership behaviors.
The opportunity for charge nurses to participate in professional development programs was recommended for every healthcare hospital. Because healthcare is evolving at such a fast pace, hospitals should provide programs to instill leadership characteristics that empower charge nurses to meet the challenging demands of being a leader (Duygulu &Kublay, 2011). To help nurses meet the challenge, Koloroutis (2004) recommended utilization of the theory-based driven RBC leadership development program. However, Galuska (2012) reported, regardless of the position held or program attended, nursing leadership must provide strategies to help mentally prepare the charge nurse to take on the demanding role.
After program participation, Duygulu and Kublay (2011) projected transformation of charge nurses into RBC leaders may be recognized by the positive impact made on outcomes in metrics such as patient satisfaction, staff turnover, length of stay, and quality nursing sensitive indicators. The RBC model could be useful in formulating a
transformational education program that could help bring about positive changes in staff and patient outcomes (Koloroutis, 2004). Identified in the RBC model are particular leadership skills missing in the hospital’s current charge nurse program such as staff and patient working relationships, conflict resolution, life and work balance, and shared governance. The program’s goal was to investigate if participation in a RBC
transformational leadership development program leads to charge nurses obtaining personal, professional and hospital goals, that in the end, support quality patient care and outcomes (Koloroutis, 2004).
One study that successfully implemented RBC was a rural hospital that conducted a study from the third quarter of 2010 to the second quarter of 2013. The hospital integrated the RBC principles of Felgen’s inspiration, infrastructure, education and evidence model (I2E2). Inspiration included conducting nursing theory searches that agreed with the hospital’s mission and vision statement of promoting caring behaviors. Infrastructure was approached by formalizing work specific strategies such as workshop attendance for improving patient, family, and team communication. The project leaders strengthened the education process by incorporating preceptor programs,
transformational leadership workshops and unit based council training. The evidence of the RBC impact showed the Hospital Consumers Assessment of Healthcare Providers and Systems (HCAPHS) Top Box Score for 2010-2013 in patient satisfaction for the “rate hospital” improved from 67.4 to 70.2 and improved at the “recommend hospital” from 69.9 to 71.5. The “communication with nurses” on the Top Box scores for this hospital improved from 78.4 in 2010 to 83.2 in 2013. In addition, the “RN engagement” score was 28 for other similar-sized hospitals and 38 for the study hospital; a 10%
increase above the benchmark over other hospitals. These scores, although small, showed
important improvements in caring behaviors(Transforming Practice, n.d.)
A second study conducted by Sharpnack and Koppelman (n.d.) used the RBC model of the I2E2 to connect theory with practice. The concepts of moral courage and skill development were RBC principles used to emphasize professional practice and competencies in achieving nursing leadership while in nursing school. Sharpnack and
Koppelman reported the evidence for incorporating the caring behaviors lead to improved skills following leadership development and an increase in self-care awareness in clinical practice. The study participants utilized learned leadership skills as evidenced by the demonstration of caring behaviors at the bedside.
A third study in a rural Kentucky hospital piloted the RBC model to evaluate if implementation of caring behaviors and attitudes strategies taught to medical, surgical and telemetry unit nurses would increase outcome metrics such as HCAHPS scores. To accomplish the goal, the program leaders taught staff simple steps to communicate caring behaviors that included the use of active listening skills. Some of the barriers to program implementation included small sample size (n=20), lack of incentives, consequences and buy-in. The results of the study showed no statistically significance differences in caring behaviors and attitudes but did show increases in four out of the five perimeters of caring such as using touch and listening (Roberts, n.d.)
GeneralLiterature of Charge Nurse Leadership
The nursing literature review of five articles reported a positive correlation when charge nurses participated in a leadership development program on the concepts of job satisfaction, staff and patient outcomes, and leadership abilities. Casey, McNamara, Fealy and Geraghty (2011) used a mixed method descriptive study to describe the
developmental needs of nurses and midwives. The authors concluded self-awareness and clinical leadership must be part of leadership development. MacPhee, Skelton-Green, Bouthillette and Suryaprakash (2011) also used a descriptive study to report the outcomes
of a nursing leadership development program on empowerment. The study findings suggested empowerment and charge nurse development led to empowerment of others. McCallin and Frankson (2010) used a descriptive exploratory study to investigate the experiences of charge nurse managers and found taking on the role required formal training and supervision to improve role development. Galuska (2012) conducted a metasynthesis of qualitative studies on leadership development and found program participation could either support or hinder a nurse’s development as leader. Krugman, Heggem, Kinney and Frueh (2013) reported participation in a leadership development program prepared charge nurses in the role of “supervising, evaluating, and disciplining staff” and also “how to lead day-to-day patient care unit issues” (p. 443). The five studies authors supported the necessity for participation in a leadership development program to transform nurses into effective leaders. The support of a formal educational program is one strategy that nursing leadership can easily incorporate into practice to help develop charge nurses whom effectively influence patient outcomes.
A transformation leader is one who formulates goals, seeks, and welcomes input from followers before making decisions (Convey, 2004). Convey described the
transformational leadership style as collaborative and consensus seeking to enhance professional skills. It was further implied that a goal of the transformation leader is to affect the heart and mind of the people and to provide a singular vision and understanding of the hospital’s values. This congruence of vision and values creates lasting change within the agency when all workers agree.
According to Chen, Bian and Hou (2015), followers who supervisors
demonstrated transformational leadership traits positively affected their job performance. Followers of transformational leaders also reported they felt inspired to create a positive workplace for themselves and others. Chen, Bian and Hou further reported that often in a workplace where supervisors are encouraged to develop into transformational leaders, employees experienced high levels of satisfaction. The resulting impact of
transformational leaders on assisting followers in making hospital decisions to influence workplace outcomes is usually positive.
Duygula and Kublay (2010) conducted a study using The Leadership Practices Inventory of Self and Observer instrument to examine behaviors and to evaluate the changes made after participation in a charge nurse leadership program. The study results supported that attendance in a charge nurse program may assist charge nurses develop a new way of thinking about their accountability and responsibility as leaders. Duygula and Kublay reported they selected to use an evaluation design to provide evidence regarding benefits and limitations of actual research experiments, methods and outcomes.
Krugman et al. (2013) defined the development of the charge nurse leadership role as critical to the hospital’s survival. The effective leader facilitates mediation of patient problems, appropriate designation of nursing assignments based on staff
competence, and provides correct care coordination across departments and disciplines. Thomas (2012) also identified transformative characteristics learned in a charge nurse
development program leads to an increase in confidence, decision-making and assertive communication techniques.
Krugman et al. (2013) evaluated the longitudinal outcomes of a leadership
program for permanent and relief charge nurse from 1996–2012. The authors used action research and Kouzes and Posner’s The Leadership Challenge conceptual frameworks to identify the effectiveness of charge nurse program participation. The results supported charge nurse leadership development improved regardless of how the program and interventions were provided. Therefore, it is suggested participation in a formal development program may enhance a charge nurse’s ability to lead teams effectively.
Manion (2005) reported healthcare workers may experience overwhelming feelings of desperation when asked to assume greater responsibilities involving decision making and leadership issues previously undertaken by managers. Covey (1989) reported when nurses are promoted to positions of leadership without proper management training, guilt and effects of decreased self-esteem can be experienced. Convey also reported that some leaders believe that nursing management and nursing leadership are the same; where in actuality they are two different concepts. Management is related to the nursing unit operation and expense, whereas leadership is related to the people and patients on the unit. The concept of possessing both leadership and management skills rolled into one person defies possibilities in the current charge nurse system (Convey, 1989).
Conceptual Models and Theoretical Framework
The study is based on the RBC model. The model is not a new concept in nursing but it was new to the participating project hospital. Koloroutis et al. (2004) reported the RBC model is an adaptation of primary nursing. According to Koloroutis, hospitals that implemented this model reported an increase in patient satisfaction and loyalty, an increase in staff and physician satisfaction and a more resource-conscious and efficient environment. The CHCM company reported the model was created to help transform hospitals into an environments that brings about a culture of caring that focuses on consistent care of patients, others and self (Koloroutis, 2004). The RBC model is
comprised of three crucial relationships: “care provider’s relationships with patients and families, care provider’s relationships with colleagues, and care provider’s relationship with self” (Koloroutis, 2004, p. 4). These RBC principles help empower leaders to make important decisions and bring out leadership creativity, vision, and build on the present strengths and capacities of the leader. The RBC leader is also a role model who displays caring behavior and demonstrates self-empowerment attributes to patients, staff and self (Koloroutis, 2004).
A nursing theory found appropriate to guide this program was Benner’s novice to expert theory. The theory is composed of five important levels of experience identified in the development of clinical knowledge and expertise (Benner, 2001). The five levels of experience are (a) novice is the new nurse who comes to the healthcare setting with little to no clinical experience other than textbook knowledge; (b) advanced beginners start to
apply textbook knowledge and learned clinical knowledge to patient care decisions; (c) competent nurses critically think of the patient’s needs by reflecting on pass learned experiences and apply them with little assistance; (d) proficient nurse are those who anticipate patient’s needs in advance and act on established beliefs; and (e) expert nurses demonstrate clinical judgment and require minimal guidance when making healthcare decisions affecting patient care outcomes (Benner, 2001). Groves, Burns and Gray (2013) reported nurses who felt they were competent attributed their clinical practice
development to remaining in the same position for two or more years. The charge nurse entry level is competent with at least two years’ clinical experience in this hospital. The charges nurses, after time, exposure and experience, are expected to advance forward to proficient and finally develop into clinical experts. Finally, expert level charge nurses are usually promoted to management positions with more hospital responsibilities.
Cooper (2009) suggested promotion of professional development in the work place may reduce the nursing shortage and bring about job satisfaction in nursing leaders. Cooper used Benner’s novice to expert theory to identify levels of competence as a theoretical framework to help develop charge nurses. The author also stated, “reducing nurses’ frustration while attending development programs can occur when Benner’s five levels of practice are used to match nursing education with experience” (Cooper, 2009, p. 504). The study results supported attendance in a formal training program enables charge nurses to perform at their fullest leadership potential. Benner’s theoretical framework
when applied appropriately in charge nurse development programs can possibly lead to job satisfaction and increased nurse retention in the hospital (Cooper, 2009).
Swearingen (2009) also used Benner’s novice to expert framework to determine levels of education needed for leaders. Swearingen recommended when curriculum is started from the novice level or from the ground up, front-line leadership is enhanced during training. Swearingen also reported when a curriculum is built from the novice to expert level of leadership, nurses’ knowledge advances from the fundamental role to learning the meaning of taking on the full responsibility of the leadership position.
Swearingen implied that the application of Benner’s novice to expert theory in a leadership development program identifies strategies needed to cause changes in self-confidence, autonomy, and job satisfaction in charge nurse participants. Benner’s theory is considered an essential component to improve nursing practice and increase nursing knowledge about leadership concepts. The use of Benner’s theory in the leadership development program will also help leaders to focus on and identify individual charge nurse’s strengths and weaknesses. The theory’s contribution to nursing provides
information on how leadership development programs are conducive to increasing charge nurse’s knowledge of leadership thereby leading to positive behavior changes. However, Swearingen also implied further nursing research is needed to examine in what ways Benner’s theory improves leadership development in the charge nurse. Therefore, the application of the novice-to-expert theory in the program will add knowledge to what is already known about the professional development of charge nurses.
Summary
As revealed from the evidence based literature search and review of leadership development, the need for a reduction in practice gaps in charge nurse development is a national and international healthcare concern (Cooper, 2009; Maryniak, 2013;
Swearingen, 2009). Effective implementation of charge nurse programs is one way suggested that can make a huge societal impact on how healthcare education is delivered now and in the future. Future evaluation of the impact of charge nurses’ leadership abilities on hospital metrics after participation in a RBC leadership program may be the answer. In other words, professional development must be promoted if nursing practice is to be seen as a discipline of excellence. With the increasing role demands of supervising staff and delegating care of the critically ill, every charge nurse must be equipped emotionally to be a leader. It is the responsibility of the educational system and the hospital to equip nurses to meet the demands of the role by making available
developmental programs that transform charge nurses into effective and empowered hospital leaders. The use of the RBC concept model and Benner’s novice to expert nursing theory are supported in the literature for providing transformational programs to help develop charge nurses who are competent leaders.
The project team used the findings of the RBC literature to develop, design, plan, implement, and evaluate a transformational program that fosters charge nurse
development. The project team also made recommendation on data collection and analysis of the programs results for the hospital after completion of the program. In the
methodology section, the study population and sample, the program modules and the study survey tools are discussed.
Section 3: Methodology
The purpose of this quality improvement project was to provide evidence-based literature on the best way for the hospital to implement a RBC leadership program for charge nurses. The RBC program focused on strategies to develop leadership
competencies, leadership confidence, and leadership abilities in medical-surgical charge nurses. In the future, the hospital will measure the impact of program participation as determined by self-reported increases in charge nurse leadership skills and abilities. In
addition, positive outcome changes on post-implementationcore measure scores and
other unit metrics will determine whether the charge nurse program was effective. Approval was obtained from Walden University IRB to implement the project: IRB Materials Approved. This Confirmation of Ethical Standards (CES) has an IRB record number of 07-11-16-0462742
Approach
The approach for this quality improvement project was for the development, implementation, and evaluation for blending the CHCM RBC principles into the hospital’s current charge nurse program. The inclusion of the RBC principles was
supported by the evidence-based findings that combining the two programs may cause an
increasein medical-surgicalnurse’s leadership abilities (Koloroutis, 2004). As the DNP
those nurses working on the medical-surgical unit and employed at this acute care hospital in the southwestern portion of rural Oklahoma, I made future recommendations for the project team to obtain approval from the hospital’s quality improvement
committee to implement the program. The recommendation was for the protection of human subjects to consist of implied consent in the form of voluntary program attendance
and completion of the (LPA) presurveyand planned post surveyinstruments. I
recommended that the hospital’s assigned project committee team members provide sufficient explanation of the project’s instruments and completion requirements to participants before taking part in the program. My recommendation was for the charge nurse project participants to attend a structured one-day, eight-hour program in a
classroom setting that covered relationship-basedcare topics for volunteers but who are
then selected by the unit managers. The selection of participants would continue until all medical-surgical RNs or potential charge nurses had attended the program. I
recommended that the program be offered outside the hospital setting to help reduce role distractions and other pressing charge nurse responsibilities. I also recommended
combining the hospital’s current charge nurse program with the evidence-based RBC leadership program. I recommended the following charge nurse program modules be implemented in the future, at a time and location agreed upon by the hospital.
Course Objectives
• Examine the charge nurse’ job description with role expectations, behaviors
• Articulate the concepts of the RBC model.
• Identify principles of RBC leadership styles and empowerment.
• Reflect on the responsibility, accountability and authority of the charge nurse.
• Apply techniques used in team building and trusting relationships activities.
• Discuss strategies that increase effective communication and listening skills.
• Explore conflict management strategies
• Define the positive feedback of using appreciative inquiry
Course Modules
Module 1: Charge Nurse’s Role and Job Description
The chief nursing officer (CNO) opens the session to clarify the job description, role and responsibilities of the charge nurse as defined by the hospital. The CNO
explains the inclusion of the RBC principles of leadership added to the current program. Nurses in leadership positions must understand and demonstrate caring behaviors toward others and self to be effective in the role (Koloroutis, 2004). This session should take approximately 20 minutes to complete.
Explain the Job Description of the Charge Nurse:
• Provide a definition of a RBC charge nurse.
• Define the role of the charge nurse
• List the responsibilities of a charge nurse
• Elicit participant’s verbalized expectations from program attendance
The project leader will define leadership styles of effective leaders. Watson’s
theory of human caringas selected to explain different leadership styles and behaviors
inherent in successful leaders such as teacher, support person and guide (Koloroutis, 2004). The Creative Healthcare Management LPA survey tool will be explained by program leaders. Following the introduction of the LPA, participants will voluntarily complete the self-assessment preintervention survey tool. This session should take participants approximately 25 minutes to complete.
Leadership Styles and Program Pretest
• Participants will brainstorm and list on a flip chart favorite leadership characteristic identified by participants in an effective charge nurse.
• Participants will role model positive attributes and traits of the charge nurse.
• Program leader will provide an explanation of the pretest instructions for
completing the Leadership Personal Assessment (LPA) tool.
• The designated program leaders to collect and store completed surveys
Module 3: Foundations of Empowerment
This module includes a videotaped program on empowerment. The charge nurse must recognize the quality needed to empower self and others under their care and authority. This includes evaluation of performance, correct use of available resources and direct management of the unit staff (Schwarzkopf, Sherman, & Kiger, 2012). Completion of this module should take approximately 30 minutes.
• Identify behaviors expected in a safe practice environment.
• Assist participants to create a shared leadership vision.
• Lead participants in interactive empowerment role play techniques
Module 4: Responsibility, Authority, and Accountability (R+A+A)
The R+A+A strategies of leadership such as delegation, prioritization, role expectation and scope of practice guides this session. R+A+A provides a clear process for leaders to reach optimal results when duties are recognized and accepted (Koloroutis, 2004). The RBC concepts of responsibility, accountability and authority expected in the leadership role are identified (Koloroutis, 2004). This session takes approximately 45 minutes to complete.
• Define responsibility as the ability to function within the scope of practice and
duties. Discuss how to get through a day with all the responsibilities.
• Define authority as the responsibility to act appropriately in delegation of
assignments, of being a resource to subordinates, and communication with leaders. Discuss being emotionally available as the leader in charge.
• Define accountability as taking ownership of decision making in areas of
prioritization and role expectation. Discuss how the charge nurse is accountable for being accessible and clinically competent.
Module 5: Disciplines of Execution using principles of I2E2
Felgen’s 2007 I2E2: inspiration, infrastructure, education, and evidence model will be used to teach charge nurse leaders how to use the mission and vision of the
hospital to bring about lasting relationship-based care changes in the hospital (Koloroutis, 2004). I2E2 help leaders identify care delivery strategies that cause thorough patient care, create happy families, support satisfied staff who feel they give good care and encourage interdepartmental harmony. This module should take approximately 15 minutes to complete.
• Complete the positive shift outcomes exercise.
• Identify measures to ensure shift coverage.
• Identify strategies that help to maintain timely patient flow.
• Identify measures to ensure shift coverage. Identify strategies that help to
maintain timely patient flow.
Module 6: Building Trusting Relationships
Hospitals desiring to successfully teach leaders to build trusting relationships must provide support to team members in the effective development of mutual respect and trust between self and others. Teaching strategies geared at developing positive communication skills, delegation and prioritization must also be advocated for new leaders (Koloroutis, 2004). This module’s interactive games and role-playing scenarios should take approximately 45 minutes to complete.
• Share the RBC Commitment to Co-workers card
• Identify the role of teamwork in build trusting relationships
• Elicit ways to provide reminders to people who fail to build trusting
Module 7: Crucial Confrontations
Charge nurses must learn how to recognize and manage crucial confrontation with
difficult personalities. Nurses who areill-prepared to directly confront team members
who disrupt the flow of the unit and the hospital face losing trust and respect from patients and staff. Therefore, teaching strategies to increase leaders on how to recognize and handle confrontation is essential. This session should take approximately 30 minutes to complete.
• Share the crucial confrontation PowerPoint presentation.
• Complete the crucial confrontation exercise.
• Interact within small group discussion and provide a role play activity of the
scenarios.
• Participate in interactive conflict case scenarios and resolutions between
nurse-doctor, nurse-nurse and nurse-patient
Module 8: Effective and Ineffective Communication
This module will expound on communication styles through interactive group activities and role playing. Interactive or hands-on activities creates an awareness where leadership behaviors change from being problem focused to solution focused (Fairbairn-Platt & Foster, 2008). The completion of this should take approximately one-hour.
• Teach participants the GRIEVE Model to solving shift problems.
G-gather the information. R-review or restate the problem. I-identify potential solutions. E-evaluate alternate solutions. V-verify and implement the decision.
E-evaluate the results. Performing the GRIEVE model is a version of the Plan, Do, Check, Act (PDCA) process.
• Identify barriers that hinder good communication.
Module 9: Appreciative Methods
The RBC principles of appreciating others and self helps leaders recognize what works within the hospital. The use of appreciative methods leads to positive patient and staff outcomes (Koloroutis, 2004). Completion of this module should take approximately 45 minutes.
• Complete the personality test.
• Practice writing appreciative comments.
• Discuss punitive discipline versus positive discipline.
• Discuss the importance of bedside report, hand-off and hourly rounding.
• Promote importance of ongoing staff education and training.
Module 10: Lean Methodology
The Lean methodology places emphasis on hospital resource utilization. Lean improvement steps assist charge nurses in identifying strategies on the elimination of waste of time, effort and valuable resources. Lean strategies also help leaders identify ways to increase unit productivity. Completion of this module should take 45 minutes.
• Share the LEAN Methodology Microsoft PowerPoint presentation.
• Create effective time management strategies on what is important to complete
• Identify strategies to increase efficient care such as reduction in overtime, increase in staff retention, and increase in patient satisfaction.
• Discuss the utilization of the capital budget such as ordering equipment, unit
remodel and hospital remodeling.
• Discuss staffing metrics, core measures and customer service.
• Educate on how to maintain and sustain unit changes
Module 11: Hospital Nuts and Bolts
The charge nurse’s role in maintaining the hospital’s infrastructure is important for new leaders to understand human resources policies and procedures issues. The completion of this module should take approximately 30 minutes.
• Discuss how to read financial reports.
• Educate participants on the nursing recruitment, interviewing and hiring
processes.
• Discuss how to read staffing grids.
• Completion of disciplinary reports, occurrence and employee injury reports.
• Identify issues requiring assistance from the manager or house supervisor.
Module 12: Summary, Self-Assessment Posttest and Program Evaluation
Preintervention and postintervention survey differences assist project evaluators to measure expected leadership behavioral changes achieved following program
additional development and those who are ready to take on the role and responsibilities. The completion of this module should take 30 minutes.
• Open session for participant’s program questions and answers.
• Repeat the LPA as a post intervention tool.
• Complete the program evaluation tool.
Population and Sample
The recommendation for this future developmental project implementation was for the program leaders to seek project approval from the hospital’s quality improvement
councilfor charge nurse participation. The recommendation was for the future target
population consist of registered nurses with at least two years of clinical practice experience. The future recruitment of participants should occur from a convenience sample of medical-surgical registered nurses employed at the hospital and who will voluntarily commit to and participate in a one-day, eight-hour charge nurse program. The project participants should consist of full-time registered nurses, with-or-without prior formal training, who have worked for the hospital as a charge nurse or who are potential charge nurses in the future. It was recommended that the unit nurse manager or unit director identify, approve and select from nurses who volunteer and who meet criteria for project participation. The demographics of age, race, nursing education level or gender will not be considerations for project inclusion (see Appendix D). The criteria for project exclusion are registered nurses with less than two years of clinical practice, charge nurses
from non-medical-surgical units, nurses from critical care, licensed practical nurses, part-time employment status and travel or agency registered nurses.
Program Design
The DNP project leader and project committee members recommended the quality improvement charge nurse program utilize already established concepts found in the CHCM RBC leadership program. The recommendations included that the program be held in a conference style room selected by the education department at a convenient location. I recommended the program be conducted over one eight-hour class period as suggested by the CHCM team. The recommendation was for registered nurse participants to complete the Leadership Personal Assessment Survey preprogram and post-program intervention and repeated at the assigned time intervals. The future participants will be allowed random opportunities to contact the assigned program leaders for clarification to any unanswered program questions.
Data Collection
The data collection process will be performed at this rural hospital by the hospital’s project committee at the selected hospital located in rural southwestern Oklahoma at pre-determined times. I recommended the committee first gain permission to conduct the quality improvement project at the hospital prior to program
implementation. Next, the hospital’s quality improvement council will seek written permission for registered nurse participants to volunteer from within the hospital. Finally, the senior director of operationsand unit directors will be asked to provide a list to the
